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MA Health Care Reform 2007-2008 Progress Report


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The data, timeline and stories of Health Care Reform in Massachusetts

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MA Health Care Reform 2007-2008 Progress Report

  1. 1. Massachusetts Health Care Reform 2007/2008 Progress Report
  2. 2. Message from the Chairman of the Board and Executive Director After two years of comprehensive efforts throughout the Commonwealth, Massachusetts has added nearly 440,000 people to the rolls of the insured. In doing so, we have moved reform from an experiment to a success and have solidified its popular support. This summary report, which accompanies a lengthy, formal report on the Health Connector to the Massachusetts Legislature, reviews the progress achieved in implementing Health Care Reform in its first two years. The most tangible measure of progress is the decline in the number of uninsured. Enrollment has occurred rapidly, ahead of expectations. Our Commonwealth Care program for low-income individuals has grown to 173,000 through August of 2008 and is making health insurance accessible to individuals who, up until now, went without. Some 43% of the newly insured are enrolled in private plans, not subsidized by the state, and a survey by the state Division of Health Care Finance and Policy for the first 21 months of the law’s implementation shows that there is little evidence of a shift in enrollment from the private to the public sector. Furthermore, independent surveys of likely voters show steady progress in public support for the new law, as high as 71% in one study. But most importantly, Health Care Reform is improving the lives of the citizens of Massachusetts. Newly insured individuals have access to the full range of care they need, including preventive care to keep them well. Indeed, a study by the Urban Institute shows that both low-income and higher-income adults report that they are less likely to have unmet health care needs since the law was implemented. In this report, newly insured individuals tell their own stories, because those stories are fundamentally what Health Care Reform is all about. For example, Jaclyn Michalos, diagnosed with breast cancer shortly after joining Commonwealth Care, explains that having health insurance saved her life by enabling her to seek the care she needed without delay and worry about cost. Lynne Gassiraro, who is self-employed, now has the peace of mind of knowing that her new Commonwealth Choice plan provides financial protection against a number of serious health conditions she battles. The Legislature, in its wisdom, asked the Health Connector’s Board of Directors to make some groundbreaking and complex policy decisions to fully implement the new law. Comprised of individuals from diverse backgrounds and points of view, the Board has worked to make these decisions in a thoughtful and transparent manner, emphasizing cooperation and consensus. Governor Deval Patrick and his Administration have worked tirelessly to ensure the success of the new law. The Massachusetts Legislature has shown unflagging commitment to Health Care Reform under the leadership of Senate President Therese Murray, House Speaker Salvatore DiMasi and Health Care Financing Chairs Richard Moore and Patricia Walrath. And finally, the Health Care Reform Coalition, made up of organizations, businesses and community groups who came together to support passage of reform, have held strong in their commitment to making it a reality in Massachusetts. This Summary Report outlines progress to date for the newly created Health Connector and Massachusetts Health Care Reform. This summary is largely descriptive, as is the full report to the Legislature. Implementation of Health Care Reform is a three-year process, and many of the initiatives are still evolving. As these programs mature and we accumulate experience and data, we will turn increasingly toward evaluation and report our findings. Leslie Kirwan, Chair Jon Kingsdale, Ph.D. Secretary for Administration and Finance Executive Director, Commonwealth Health Insurance Connector Authority
  3. 3. Health Care Reform is literally saving the lives of people like Jaclyn Michalos of Norwood who is now cancer-free after undergoing treatment for breast cancer. Contents The Results Are In.................................................4 Key Policy Decisions...........................................12 Public Education and Outreach Campaign....14 Commonwealth Care.........................................18 Commonwealth Choice.....................................20 The Commonwealth Health Insurance Connector Authority is an independent state agency that helps Massachusetts residents find health insurance coverage 3 and avoid tax penalties.
  4. 4. The Results are In Two years after passage incomes in October 2006 for a of Massachusetts’ November 1 effective date, and landmark Health three months later extended this Care Reform law, nearly 440,000 offering to those from 100 to 300% individuals are newly insured. of the federal poverty level (fpl). Nearly half of the newly covered Commonwealth Choice, the Health are enrolled in private plans with Connector’s program for individuals no government subsidies. To date, not eligible for subsidized coverage, there is little evidence of crowd- opened in May 2007, for an effective out, or the shifting of enrollment date of July 2007. from the private to the public sector. A report by the U.S. Census The three-year phase-in of Health Bureau shows that gains made in Care Reform in Massachusetts enrollment in Massachusetts since continues with an increase the law was enacted have propelled in tax penalties for 2008 and the state from seventh place in the implementation of new standards percentage of insured citizens to for Minimum Creditable Coverage in first place for the 2006 and 2007 2009. Also planned for early 2009 is period. The following report to the the extension of the Commonwealth Massachusetts Legislature details the Choice program to small employers state’s experience with Health Care Reform at its early stages. Two years after beginning implementation and phase-in of the law, Massachusetts has passed Implementation Begins Chapter 58 of the Acts of 2006, was a number of significant milestones. signed into law in April of 2006. Most importantly, more Bay Staters Work on implementation began now have health insurance. Based immediately with the expansion on information collected by the of MassHealth eligibility and the Division of Health Care Finance promulgation of the first set of and Policy (DHCFP), 57% of the emergency regulations from the almost 440,000 newly insured are Massachusetts Health Insurance enrolled in Commonwealth Care Connector Authority. or MassHealth and 43% are in private insurance. Well over half The Health Connector first began of the new enrollees contribute to offer subsidized coverage for all or something significant to the uninsured adults with the lowest premium cost of their coverage and
  5. 5. incur co-payments and other cost- efforts to reach consensus are in sharing in line with private employer- keeping with the earnest efforts of sponsored insurance. (This DHCFP many interested parties dedicated data is from the first 21 months of to implementation of the landmark the law’s implementation, from June legislation. of 2006 through March of 2008.) Soon after its enactment, popular Based on data from fall of 2007— support for Health Care Reform was both survey data and tax filings already high. Remarkably, in the — the number of uninsured in two years since, public support in Massachusetts has fallen substantially. Massachusetts has actually increased. A state survey of the uninsured due out at the end of 2008 will provide more definitive information on the remaining number of uninsured. In addition to launching two major coverage programs in its first year — subsidized Commonwealth Care and unsubsidized Commonwealth Choice — the Health Connector’s Board of Directors met 25 times to wrestle with a number of critical and high profile policy decisions. Most of these matters were decided unanimously. The Board’s successful 5
  6. 6. And beyond our borders, this legislation is often examined as a possible model for national health reform. Due in part to an aggressive public education program, enrollment growth in Commonwealth Care peaked just as the individual mandate penalties came into effect at the end of 2007. With the introduction of a comprehensive process for annually re-determining eligibility, enrollment in Commonwealth Care leveled off in March 2008 at approximately Having health insurance is helping people 176,000 while growth in MassHealth has reached about 72,000. The like Madelyn Rhenisch reclaim their lives. Health Connector projects that growth in the program will soon “Your job ends, accidents occur and health issues arise,” said resume. The portion of premium- Madelyn. “And when you have health problems and no insurance, paying enrollees in Commonwealth you struggle. I stopped getting routine and preventive care, saw Care continues to grow, as does doctors only when I couldn’t find any self-help way of healing myself, enrollment in private, commercial and I lived in fear of an illness or accident that I wouldn’t be able to insurance. afford.” The rapid pace of the growth in When Madelyn did develop health issues, it didn’t take long for her Commonwealth Care has generated to lose all the retirement money she had worked so hard to set cost concerns. In fact, spending on aside. Commonwealth Care exceeded early On Oct. 2, 2006, she became the first person in Massachusetts to budget projections for FY 2008 by enroll in Commonwealth Care, one of the Health Connector’s over $150 million. However, as a landmark programs that provides quality care at a reasonable price. relatively new program expected Today there are some 440,000 newly insured in either public or to grow at rates which can only private market insurance. be estimated in its early years, enrollment growth is more an “I no longer live in fear of the next illness or accident,” said Madelyn. indicator of need than anything else. “Without the foundation of health, you cannot hold your own or On the basis of cost per member per contribute.You cannot use your skills and resources to build a month, Commonwealth Care has strong life and community.” tracked close to budget for the past two years. Madelyn no longer has to decide between medicine and food. She now gets the routine care she needs, and as her health is restored, Meanwhile, a look at available data she feels secure and is filled with hope. begins to paint a picture of initial success, not only in covering more “I am proud to live in the first state to take on the responsibility individuals, but in improving access of ensuring health care for all its citizens,” said Madelyn. “Whatever costs are incurred are more than repaid by the ability of people to routine care and reducing reliance like myself to regain their health and step back into the role of on “free care.” A survey by the Urban contributing citizens.”
  7. 7. Institute reports that from the fall of 2006 to the fall of 2007, the number of uninsured adults in Massachusetts dropped almost in half, from 13% to 7%. Because seniors and children were not included in the survey and have far higher rates of insurance than working-age adults, the overall percentage of uninsured was likely lower. Moreover, the survey was conducted in October and November of 2007, before penalties for complying with the new law went into effect, prompting a large surge in enrollment. The Urban Institute findings are corroborated by the annual U.S. Census Bureau survey that showed the state’s average uninsured rate for the two-year period, 2006- 2007, dropped to 7.9%, making Massachusetts the state with the lowest rate of uninsured residents in the country. As predicted, the use and cost of the Health Safety Net for the uninsured is falling. As reported by DHCFP utilization of free care , had declined by 37% and payments declined by 41%, in the first quarter of Health Safety Net fiscal year 2008 over the same quarter a year earlier. As intended under the new law, increasing subsidies for insurance and constricting eligibility for the Health Safety Net are moving cost from institutional subsidies to individual and comprehensive coverage. The state Department of Revenue (DOR) has been a strong partner in the implementation of Health Care Reform. Communications to tax filers and employers explaining their responsibilities under the law have been undertaken through DOR, which is also responsible 7
  8. 8. Of those Massachusetts taxpayers who reported not having health insurance, 3% (97,000) were deemed able to afford coverage, but self- assessed a penalty for not having it; the remaining 2% (71,000) were exempt from the requirement, either because they could not afford to purchase insurance, or because of their religious beliefs. As of August 2008, only 2,411 Massachusetts residents out of some 3.3 million filers had actually appealed the 2007 for implementing the schedule of penalty decision. tax penalties. DOR also serves as a source of important data about Of the nearly 440,000 newly insured, compliance. The department as of March 2008, about 176,000 confirms a high level of coverage were enrolled in the Commonwealth among adults through state income Care program, 72,000 were receiving tax filings for 2007. Just 5% of some MassHealth, the state’s Medicaid 3.3 million tax filers reported being program, and 191,000 had enrolled uninsured as of Dec. 31, 2007, and in private insurance through their compliance with the new tax filing employers, the Commonwealth requirements was overwhelmingly Choice program or because they successful, with only 1.4% failing to purchased directly from a carrier. file appropriately. The 43% who are enrolled in commercial health insurance plans represent the first significant increase in private, commercial insurance in Massachusetts in decades. Over half of the new enrollees contribute significantly toward their monthly premium, whether they pay all of it--as do some 32,000 new buyers of non-group insurance--or part, as do some 159,000 new enrollees who took up their employer’s offer of insurance as well as more than 60,000 enrollees in government-
  9. 9. subsidized Commonwealth Care. Among the 32,000 new buyers of non-group (individual) insurance, nearly 50% bought through the Health Connector, and 80% of that group utilized the Health Connector’s award-winning web site for their purchases. The Uninsured The uninsured are disproportionately poor, so they 36,000 to 72,000. make up a large portion of the newly Increased access to medical care insured, but Health Care Reform is is a key goal of health reform, helping people in need of coverage and the Urban Institute study across the income spectrum. In the showed that adults across income Urban Institute study, a significant categories in Massachusetts have decline in the numbers of uninsured not only experienced increases in was evident from 2006 to 2007 for access to medical care, but have both middle class adults and those also experienced reduced out-of- earning 300% or less of the federal pocket spending and increased poverty level. use of preventive care services. In other words, Massachusetts insured It is important to note that market hundreds of thousands of people reforms generated as a result of who are now able to address the new law significantly increased previously unmet medical needs in a the choice and value of non-group more affordable way. health insurance in Massachusetts. Before reform, a healthy 37-year-old living in Boston – the median age for uninsured adults in the Bay State – paid $335 per month in premiums and had few market options. Post reform, that same 37-year-old had a broad range of options, including at least one plan for a little over half the price, with twice the benefits. In just nine months following reform of the non-group market, enrollment in individual plans doubled from 9
  10. 10. Foundation survey showing support at 75% in June of 2008, up from 70% in September 2006. Additionally the study showed that 77% of Massachusetts residents supported providing subsidized health insurance to low-income residents. The cost of the program has grown in response to enrollment growth. And, just as Commonwealth Care has grown, so has employer-sponsored Shared Responsibility insurance and private, non-group The reform law in Massachusetts insurance. To date, there is no has been an effort borne of shared evidence of significant “crowd-out,” responsibility among individuals, or behavior changes from employers business and government. It’s a or employees that would shift formula that has proved attractive enrollment from the private to the to voters. A survey by the Harvard public sector. School of Public Health and the Blue Cross Blue Shield of Massachusetts None of this is to suggest that cost Foundation (HSPH/BCBSMA is not a concern. It is the major Foundation) showed that of the concern in any successful effort 93% of Massachusetts residents who to significantly expand health say they know about the law, 69% coverage. By embracing the moral support it. That support is up from imperative to cover the uninsured, 61% in September of 2006. Similarly, Massachusetts can no longer respond Urban Institute surveys in the fall of to medical cost increases by rationing 2006 and fall of 2007 show a rise in financial access to care; instead, the favorable opinion among working- challenge of moderating annual age adults from 68% to 71%, and increases in the cost of medical those favorability ratings were similar care and health insurance must be for low-income and higher income squarely confronted. Legislation respondents. When asked in the to do just that has recently been HSPH/BCBSMA Foundation study enacted and cost containment will about repeal of the new law, only continue to be a priority in the years 12% of residents said they would like ahead. to see it repealed. Connector Authority Support for the requirement Administrative Cost that businesses with 11 or more Prior to the commencement of employees provide health insurance operations, the Health Connector or pay an assessment of up to was provided an initial investment by $295 per employee per year is also the Legislature of $25 million. As the growing, with the HSPH/BCBS
  11. 11. Connector is a quasi-public agency, it is not a budgeted line-item for the Commonwealth of Massachusetts and, therefore, does not receive annual funds from the state to offset administrative costs. As such, the $25 million initial capitalization was expected to cover start-up expenses until the Connector generated sufficient revenue from members Gabrielle Rene and Andre Bastien have enrolled in Commonwealth Care and Commonwealth Choice to cover worked hard for everything they have, ongoing operating costs. yet they found themselves without health As expected, the Connector ran a insurance for four months until they heard significant operating loss in its first about the Health Connector. full fiscal year, while staffing up, launching programs and building “When I decided to become self-employed, I didn’t know how I was initial enrollment. However, the going to be able to afford the rising cost of health insurance,” said Connector not only managed to Andre. “Fortunately, my wife told me about the Health Connector.” reach break-even at the end of FY 2008, as budgeted, but is expecting And the plan they chose cost less than what they had been paying to realize a modest net surplus for several months before. the year. FY 2008 results for the administrative budget are about “Getting started with the Health Connector is very easy,” said $5 million better than expected. In Gabrielle. “All you have to do is check them out on the Internet and the current fiscal year, the Health you’ll see all the options.You and your family will have an opportunity Connector projects a slightly better to choose the plan that works best for you.” than break-even budget, even while reducing the administrative Very shortly after signing up for a Commonwealth Choice plan, surcharge on Commonwealth Care Andre found himself in a hospital emergency room with chest pains. from 4.5% last year to 4% this year. He didn’t have to worry about spending thousands of dollars. The Connector projects spending approximately $39.1 million in FY “With the Health Connector, I am able to have good health insurance, 2009 on revenues of $39.6 million. and that gives me peace of mind,” said Andre. Gabrielle and Andre are proud of what Massachusetts is doing to reduce the ranks of the uninsured. “I am very happy to be in a state that is the leader of this new initiative. If you need health insurance, you really need to learn more about the Health Connector,” said Andre. 11
  12. 12. Key Policy Decisions Important policy and assigned the Health Connector the challenge of setting “Minimum regulatory challenges that go Creditable Coverage” (MCC), the beyond the administration of two standard of benefits needed to meet new insurance programs were the individual mandate. delegated to the Health Connector by the Legislature. The Connector MCC sets a floor. The Health established benefit packages and Connector and other state agencies a progressive schedule of co- deem any insurance benefits below payments and premium schedules the MCC level insufficient. In setting for Commonwealth Care enrollees this floor, the Connector was guided who earn more than 100% of the by the need to balance premium federal poverty level. In setting these and out-of-pocket costs, encourage in 2007 and updating them in 2008, preventive care and cover core the Board succeeded in reaching medical services. These regulations a consensus that balanced the require that as of Jan. 1, 2009, an concerns about affordability while MCC-compliant health insurance preventing the shift of cost from plan must cover a broad range of the private sector to government- medical services, including: subsidized plans and federal and state taxpayers. • prescription drugs, • visits to the doctor for preventive Most Massachusetts residents are care, before any deductible, required to have health insurance. • deductibles that are capped at The Health Care Reform law $2,000 for an individual or $4,000 for a family each year, • an annual cap on out-of- “It’s unanimous.” pocket spending at $5,000 for an individual or $10,000 for a The Board of the Health Connector includes members with diverse family (for plans with up-front- viewpoints from the business, government, labor, academic and deductibles or co-insurance), and health care sectors. Through vigorous debate and negotiation, these • no cap on total benefits for a dedicated appointees have demonstrated a shared commitment to particular sickness or for a single the success of Health Care Reform and always reached consensus on year. difficult questions of policy, including: As a result, Massachusetts is unique • Minimum Creditable Coverage, including the requirement for Rx among the 50 states in requiring benefits coverage of a broad array of medical • Affordability Schedules for the 2007 and 2008 tax years services and prescription drugs, • The appeals and exemptions process for the individual mandate capping deductibles and out-of- • Premium and co-pay schedules for Commonwealth Care pocket spending and requiring members coverage of preventive care. • “Seal of Approval” decisions on Commonwealth Choice offerings Those who cannot afford health • Rules for employers who want to offer tax-free savings through insurance are exempt under the new a Commonwealth Choice “Section 125 Plan”
  13. 13. law from the individual mandate, It will be assessed for each month By the numbers: and the Health Connector is an individual does not have health charged with defining “affordability” insurance and will be reported on • 95% of Massachusetts and annually updating this the 2008 tax return. In 2008, the residents have health schedule. Setting a fair schedule highest penalty for not having health insurance. that also maintains the integrity insurance for the entire year is $912 of the individual mandate is one for an individual. • 58% of those who of the major policy challenges of did not have health reform. The Board of the Connector Public compliance with the new insurance were succeeded in reaching consensus filing requirements and potential deemed able to afford twice on this controversial issue— resistance to the imposition of tax insurance (97,000 tax originally in 2007 and again in 2008. penalties for not having insurance filers). were major areas of concern. It was critically important to the success Tax Penalties • 37% (about 62,000 tax The individual mandate is enforced of the Health Care Reform law that filers) were deemed by tax penalties. If, according such issues be handled efficiently unable to afford health to the Affordability Schedule, and fairly. The Health Connector and insurance. a Massachusetts adult has an the state Department of Revenue affordable, MCC-compliant health have worked collaboratively to • 5.5% (or 9,000 tax insurance option, he or she needs to handle waiver requests and appeals filers) claimed a enroll. If not, the individual could related to the individual mandate religious exemption face tax penalties, unless he or she in a fair and constructive manner. from the mandate. sought and received a hardship or Of the 3.4 million Massachusetts religious exemption. residents who filed personal income Approximate data from 2007 tax filings tax returns with the state, only 1.4% (with 86% of filings processed). Although the individual mandate failed to file their forms correctly and took effect on July 1, 2007, only 2,411 have appealed the tax enforcement was tied to the last penalty. day of the tax year, Dec. 31, 2007. Adult tax filers who were not insured Supporters gather at the Massachusetts Statehouse to celebrate another or exempt from the mandate on milestone in the implementation of Health Care Reform. Speaking is that date lost their $219 personal Connector Board Chairwoman Leslie Kirwan. exemption when they filed their 2007 state tax return. Based on 2007 tax-filings to date, the 2007 Affordability Schedule exempted just over 60,000 people from the mandate and staff ’s analysis of the revised 2008 schedule suggests similar results for the current tax year. In 2008, the penalty increases substantially and is based on income and broad age groupings. 13
  14. 14. Public Education & Outreach Campaign Governor Deval Patrick addresses Health Care Reform supporters at the launch of the Public Education Campaign at Fenway Park in May of 2007. The landmark Health Care concerns and confusion about the Reform law, with its mandate that law began to mount, the Connector nearly all Massachusetts residents was tasked by the Secretaries of have health insurance and its Health and Human Services and employer requirements, necessitated Administration and Finance to lead an aggressive public education and and coordinate communications outreach campaign. More than six about the many facets of reform to million residents and some 193,000 employers, insurers, brokers, Taft- employers needed to be informed of Hartley fund administrators and the the benefits associated with having public in general, health insurance, tax penalties for not having it, and requirements To accomplish this, the Health affecting the business community. Connector launched a multi-faceted In November of 2006, as questions, outreach campaign that began
  15. 15. with its own Public Information Unit answering inquiries by phone and e-mail, and featured civic and corporate partnerships, grassroots enrollment events, direct mail, media Shopping for health insurance used to be outreach, educational forums and paid advertising across the state. a painstaking experience if you were self- While raising awareness of the new employed. Just ask Lynne Gassiraro of law and explaining its many facets, the campaign also promoted the Natick. availability of the Commonwealth Care and Commonwealth Choice “You spend hours doing research and meeting with salespeople and in programs. the end, you really don’t know what you’re getting yourself into,” Lynne said. “I changed plans three or four times after reluctantly choosing one Partnering with the Boston Red Sox, of those out-of-state, unknown companies, not realizing how inadequate the Connector launched its Connect it really was.” to Health campaign at Fenway Park in May of 2007. The Red Sox Lynne found herself in an emergency room in 2007 with a life threatening provided the Health Connector situation, a lengthy hospital stay and impending surgery. She was only 39 with support in numerous ways. For years old. instance, an information booth was set up on the Fenway Park concourse “I knew my insurance wouldn’t cover everything, but I wasn’t prepared and interviews were televised during for all the bills after I got home.” Despite having insurance, she owed games with Health Care Reform thousands of dollars. advocates like U.S. Senator Edward M. Kennedy and Governor Deval That’s when Lynne found out about the Health Connector. Patrick. The Red Sox helped with “I was surprised how easy it was to compare plans, see clearly what was additional in-stadium messaging, covered and get upfront pricing. The side-by-side comparison of products bonus advertising, space in the Red from local insurance companies was clear and easy to obtain.” Sox program, Connect to Health Days at Fenway and recently a public Lynne’s Commonwealth Choice plan came just at the right time. She service announcement from Red Sox recently had surgery for thyroid cancer and other ailments require pitcher Tim Wakefield. her to see a cardiologist, gastroenterologist, pulmonologist and two endocrinologists. The Health Care Reform Coalition, which encompassed a host “I am happy to have coverage that allows me to see specialists and have of independent organizations, the tests and treatments I need,” said Lynne. including business groups, hospitals and providers, advocates and “The Health Connector has been such a valuable resource for me. It health plans, raised funding to literally saved my life. I tell my friends to check out the Health Connector launch an advertising campaign and really compare coverage because I don’t want them to experience complementary to the Health the same problems I had.” Connector’s and worked in tandem 15
  16. 16. held enrollment sessions after religious services and went door- to-door with information and assistance. CVS Pharmacies provided in-store signage, informational materials and overhead radio announcements. Comcast provided pro bono advertising. The Associated Industries of Massachusetts, the Retailers Association of Massachusetts, and the Massachusetts branch of the National Federation of Independent Governor Deval Patrick with the Connector on an array Businesses all sponsored regional thanks Red Sox CEO of outreach efforts. The Coalition educational forums for employers Larry Lucchino for the included Partners HealthCare, in conjunction with the Health team’s Health Care Blue Cross and Blue Shield of Connector. Reform partnership. Massachusetts and its Foundation, the Associated Industries of The complete list of partnerships Massachusetts, the Massachusetts is extensive and includes: Bank Business Roundtable, the of America, Market Basket Massachusetts Taxpayers Foundation, Supermarkets, Shaw’s and Star the Greater Boston Chamber of Supermarkets, the Massachusetts Commerce, Health Care for All, the Department of Revenue, the Massachusetts Hospital Association, Massachusetts Registry of Motor the Massachusetts League of Vehicles, the Massachusetts Board of Community Health Centers, Higher Education, the Massachusetts Harvard Pilgrim Health Care, Tufts Bay Transportation Authority, Health Plan, Neighborhood Health the Massachusetts Association of Plan, Children’s Hospital, Boston, Realtors, the ACT Coalition , the Massachusetts Eye and Ear Infirmary Massachusetts Department of and Tufts Medical Center. Public Health, the International Brotherhood of Electrical Workers, A unique feature of the success of SEIU 1199, Price Chopper, Zipcar, Health Care Reform has been the the Massachusetts Association of sustained support of the various Health Plans and carriers offering private sector organizations health insurance plans through the who helped enact the law and Health Connector. who continued to support and promote it during critical phases of The state also provided grant implementation. funding to community organizations for outreach and enrollment In order to raise awareness and assistance on the regional as well as understanding of the new law, a city and town level. community-wide outreach effort was required and civic and private Market Research partnerships were critical. These Understanding the uninsured and partnerships were many and the reasons that they lacked or varied. For instance, the Greater resisted coverage was an important Boston Interfaith Organization element of the outreach campaign.
  17. 17. The Health Connector undertook market research to understand its audiences and create appropriate messaging to effectively reach them. That research showed that two basic messages resonated with the uninsured, who are disproportionately young, male adults. Protection from financial ruin in the event of an unexpected accident or diagnosis hit a chord in focus groups with males while access to preventive care appealed to women. Advertising was influenced The Health Connector groups. While helping the uninsured by market research and included launched a multifaceted enroll in heath insurance, the events television, radio, print and Internet ad campaign to build also generated regional and national applications. Ethnic media was awareness of the law news coverage. also a special focus. Direct mail and drive enrollment. was utilized with two postcards These community-wide efforts drove sent to the homes of all tax filers enrollment in health insurance and reminding them of the deadline for knowledge of the law. Independent enrolling in health insurance before surveys placed knowledge tax penalties would be incurred. of the requirement that all Similar communications were sent residents have health insurance to all employers. Additionally, the at 87% in late 2007. A more Department of Revenue sent a recent survey in June of 2008 follow-up letter to all tax filers who by the Harvard School of Public were assessed the penalty for not Health and the Blue Cross having health insurance in 2007. This Blue Shield of Massachusetts mailing explained increasing fines Foundation reports that 93% for 2008 and provided advice about of Massachusetts residents say where to obtain health insurance. they know at least something Promotional and informational about the new law. materials were also produced for widespread distribution. The Connector and its partners held 30 grassroots enrollment events across the state in conjunction with state legislators, city and town officials, local hospitals, community health centers and community 17
  18. 18. Commonwealth Care Putting Coverage within R Commonwealth Care is health, substance abuse treatment the Health Connector’s subsidized and, for some members, dental care. health insurance program that The program offers a health connects eligible Massachusetts insurance option to those individuals adult residents with approved health who may not have qualified for plans. Launched in October of a Medicaid program and those 2006, Commonwealth Care insured who may never have considered more than 173,000 Massachusetts a government subsidized health adults, as of Aug. 1, 2008. (Of that insurance program. total, more than 60,000 are paying a monthly premium.) Children of For households with incomes above enrollees are covered by MassHealth 100% of fpl, the Commonwealth without a premium. Care model closely resembles that Uninsured households with incomes of commercial insurance plans with up to 300% of the federal poverty monthly premium payments for level, currently $31,212 for an some members and co-payments individual and $63,612 for a family for services and prescriptions. As of of four, may qualify for a subsidy. July 1, 2008, premium contributions For those with family incomes up for the lowest cost plans range from to 150% of the fpl, there are no $39 to $116 depending upon an monthly premiums. Members of individual’s income. Commonwealth Care choose a Enrollment in Commonwealth Care health plan and their own doctor. has grown faster than expected Benefits include regular check-ups, due to an aggressive outreach and treatments for sickness or injury, public education campaign and the prescriptions, vision care, mental
  19. 19. each Having health insurance doesn’t fact that there were more uninsured necessarily rank individuals in Massachusetts than initially projected. high on a twenty- As the program continues to develop, the focus has shifted from enrolling something’s the uninsured to maintaining and priority list. strengthening the program for the long-term. Great strides have been made to connect individuals with health insurance. This would not have been possible without strong relationships between state agencies Lifelong Norwood resident Jaclyn Michalos knows that first-hand. An such as the state’s Office of Medicaid avid runner and former captain of her college field hockey team, she (MassHealth) and the Division of had other things to do. Health Care Finance and Policy. “Plus, it was really expensive,” Jaclyn said. After months of staff analysis, But Commonwealth Care put health insurance within her reach … board deliberations and input from just in time, because in 2007 Jaclyn was diagnosed with breast cancer. interested constituents, several program changes were instituted for “If I didn’t have health insurance, I would never have made an the benefit year beginning on July appointment with my doctor because of the cost. The cancer would 1, 2008. These were part of the first have spread and I would not be alive today to tell you my story.” program reprocurement between the Health Connector and the Medicaid It’s been more than a year since that diagnosis and Jaclyn is now Managed Care Organizations cancer-free. Not only is she back at her regular waitressing job, but in (MMCOs) that offer Commonwealth August she returned to Norwood High School to once again patrol Care plans. the sidelines as head coach of the junior varsity field hockey team. And this spring, she took part in the two-day, 40-mile Avon walk for These adjustments keep co-pays breast cancer. closer to the cost of co-pays for employer-sponsored insurance plans “I want to tell people my age that health insurance is the most and are intended to help prevent important thing you could ever have. People have insurance for their crowd-out and ensure the future cars, but too many ignore health insurance. Having health insurance viability of the program. saved my life.” Commonwealth Care plans are In addition to being cancer-free, Jaclyn has no medical debt. currently offered by: “It’s scary how much everything costs. My parents told me they • Boston Medical Center (BMC) would have taken out a second mortgage to pay my bills if I didn’t HealthNet Plan have health insurance because I have no money. I’m glad that didn’t • Fallon Community Health Plan happen to them.” • Neighborhood Health Plan • Network Health 19
  20. 20. Commonw Empowering C Commonwealth Choice provides a marketplace in which consumers can shop and compare well- known commercial health plans in Massachusetts. Tools and assistance are available so that consumers can choose the plan that is right for them. As of August 2008, more than 18,000 Massachusetts residents At 6-foot-5 inches and 225 pounds, have found health coverage through Commonwealth Choice. Andrew Herlihy of Malden is a force to Commonwealth Choice was created be reckoned with on the basketball court through the Health Care Reform when he’s not mountain biking, hiking or law to provide consumers with information and choice in the private skiing. He also has to be on top of his game market for health insurance. Prior running after-school and summer camp to the program’s creation, it was difficult for individual consumers programs for kids. to compare plans and, unlike large employer groups, they had little “I have to be very active with them, whether it’s kneeling down to get standing to push for greater value or to their level, talking with them, or playing in the gym,” said the 25- better choices. year-old Stonehill College graduate. Through Commonwealth Choice, the Unfortunately, he spent a stint on the disabled list when he injured his Health Connector negotiates directly knee and didn’t go to the doctor because he couldn’t afford it. Instead, with the health plans. Offerings that he says, he spent four months in “extreme pain.” meet standards for affordability and value receive the Health Connector’s It wasn’t until after that injury that he saw a Health Connector ad on Seal of Approval before they are the subway and decided to purchase a Commonwealth Choice Young offered to consumers. Consumers Adult Plan. can then shop, compare and enroll “I’d been putting it off, but I knew I needed it,” Andrew said. by phone or online using the Health Connector’s award-winning website, Soon after that, he was playing basketball again when he tore the meniscus in the previously injured knee. This time his insurance card gave him a speedier road to recovery. He was able to see a specialist, The Health Connector has reduced was fitted for an immobilizer, underwent physical therapy and was back cost, and has held down premium to work and on the basketball court. increases. New plan offerings in the second year of Commonwealth “Before I hurt my knee, I was one of those people who thought I Choice had an average premium didn’t need health insurance. It’s a miniscule price to pay to ensure that increase of 5 % - progress in a you can continue with your every day activities. My insurance helped market that had characteristically get me back to the basketball court and doing what I love doing more experienced double-digit increases. than anything - working with kids.”
  21. 21. ealth Choice According to data on non- group enrollment from onsumers the Division of Health Care Finance and Policy, Commonwealth Choice accounted for 50 % of the Commonwealth Choice provides Adult Plans (YAPs). YAPs total growth in the non-group health insurance through three main were authorized by the (or individual) market for channels: Health Care Reform law insurance in Massachusetts to help address a well- from its inception to documented disparity: Direct-to-consumer plans. Launched in May 2007, a complete young adults make up a March 31, 2008. consumer shopping experience disproportionately large – online or by phone – gives share of the uninsured, Massachusetts consumers their first- in large part because ever, one-stop-shopping opportunity they use relatively little medical to compare health plans on price care and earn less than older and benefits and to enroll. adults. The marketplace needed new options to respond to the way To help consumers sort their young adults perceived their health options, plans are organized into risks while offering them access to Gold, Silver and Bronze tiers, care, should anything go wrong. based on prices and benefits. An Commonwealth Choice YAPs provide additional tier of options is available lower premiums, a choice of plans Below is the home page for 18- to 26-year-olds, the Young with and without prescription drug for the Health Connector web site. 21
  22. 22. coverage, and benefits to better employees to pay for health reflect price sensitivity. YAPs are the insurance before state and federal choice of 28% of all Commonwealth taxes are applied to their paychecks. Choice subscribers. Many employers now need to offer these tax-free, “Section 125 Plan” savings to certain employees, even Commonwealth Choice Voluntary if those employees do not qualify Plan for Employers. The law requires employers with for the employer’s subsidized health 11 or more full-time equivalent benefits. employees to allow certain Once a consumer selects a tier, the Health Connector’s web site typically presents three to five plan options.* * Based on rates for a 37-year-old , average uninsured individual in Boston during August of 2008.
  23. 23. The Commonwealth Choice Voluntary Plan lets eligible employees apply these tax-free savings of 28% to 48% to the purchase of a Commonwealth Choice plan, without an employer contribution. To date, approximately 3,000 Massachusetts employers offer this Commonwealth Choice option. Membership growth has been slow but steady and stands at more than 1,000, as of June 2008. When Kay and Eugene Winakor retired to old Cape Cod last year, they were fortunate they didn’t Commonwealth Choice have to bring their old health insurance plan with Contributory Plan for Employers. When launched in the fall of 2008 them. for coverage to start Jan. 1, 2009, this program will offer a brand new way As a small business owner in Connecticut, Eugene was eligible to for small employers to offer health continue his health coverage through COBRA when he and his wife took up permanent residence in the South Yarmouth home insurance benefits to their employees they had owned for many years. with an employer contribution toward the cost. Employers will “This alternative would have cost us over $2,000 a month and we compare the Commonwealth would have to belong to a plan that may not have protected our Choice plans, make a selection, and needs,” said Kay. manage their costs by adjusting their contribution levels for employees The Winakors were delighted when they discovered the and dependents. Once their comprehensive Commonwealth Choice options that were choice is confirmed, employers will available through the Health Connector. And they were thrilled invite their employees to enroll. that the plan they selected saves them more than $600 a month. Employees will be able to enroll in the employer’s plan of choice or “The state’s Health Connector is a good program,” said Kay. apply the employer’s contribution “Most health care costs are extreme, but the Connector makes to another Commonwealth Choice the effort to help us.” plan. Health Reform has been implemented as a cooperative effort of numerous state agencies, all of whom share in its success. We want to thank and acknowledge them. Executive Office for Administration and Finance Commonwealth Choice plans are Department of Revenue currently offered by: Executive Office of Health and Human Services MassHealth • Blue Cross Blue Shield of Division of Health Care Finance and Policy Massachusetts Department of Public Health • Fallon Community Health Plan Division of Insurance • Harvard Pilgrim Health Care Division of Unemployment Assistance • Health New England Group Insurance Commission • Neighborhood Health Plan Massachusetts Board of Higher Education • Tufts Health Plan Registry of Motor Vehicles 23 MBTA
  24. 24. BOARD OF DIRECTORS Leslie A. Kirwan Chair Secretary of Administration and Finance Nonnie Burnes Commissioner of the Division of Insurance Tom Dehner Medicaid Director Ian Duncan Founder and President of Solucia, Inc. Jonathan Gruber, Ph.D. Economics professor at MIT Richard C. Lord President and CEO of Associated Industries of Massachusetts Louis F. Malzone Secretary of the Massachusetts Coalition of Taft-Hartley Funds Dolores Mitchell Executive Director of the Massachusetts Group Insurance Commission Nancy Turnbull Associate Dean at Harvard School of Public Health Celia Wcislo Assistant Division Director of 1199 SEIU United Health Care Workers East Produced by the Commonwealth Health Insurance Connector Authority Leslie Kirwan, Chairman of the Board of Directors Jon Kingsdale, Executive Director Joan Fallon, Chief Communication Officer Richard R. Powers, Editor Contributors: Niki Conte, Suzi Jervinis and Paul Wingle Design: Niki Conte Photography: Rick Bern and Bethany Versoy